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V Vision-¶ To foster a healthy society through provision of
quality health care services to all citizens·.

V Mission-¶creating an affordable and efficient health care

system, balancing preventive and curative measures and
establishing an enduring public-private partnership·.
 J The prevention, treatment, and
management of illness and the
preservation of mental and physical well-
being through the services offered by the
medical and allied health professions.

V Mobilization of funds for health care

V Allocation of funds to the regions and population
groups and for specific types of health care
V Mechanisms for paying health care
V ate 1970s Voluntary community based health insurance
attracted considerable attention
V 1980·s financing of health care moved high on the agenda of the
discussions on health policy
V Recurring theme in
ë a ecutive Board Meeting of the WHO in 1986,
ë World Health Assembly and the Commonwealth Health
Ministers Conference in 1986
V ^ser charges dominating the policy debates of 1970s and 1990s.
V Attention back on community based health insurance
V In developed countries the problem is containing the cost of health
care
V In some developing countries the problem presents itself as how
to maintain health spending and how to achieve ´health for allµ
initiative
JThe government·s fiscal effort measured as the proportion of
total government e penditure spent on health again identifies
India as a low performer.
JIn a global ranking of the shares of total public e penditure
earmarked for health only 12 countries in the world had lower
proportions spent on health.
JThe out of pocket private spending dominates with 82 percent
spending of all health spending from private sources. This is one of
the highest in the world.
JGlobally only five countries have a higher dependence on private
financing in the health sector (WHR 2000).
JAbout 10 percent of Indians have some form of health insurance
mostly formal sector and government employees.
V Ta based public sector
V Private sector including not for profit sector
V Household through out of pocket
V Insurance
V a ternal sources
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BY: GITESH SHELAR

V Berman (1997) has proposed that private care provision can be
characterized with three dimensions: Financial orientation, therapeutic
orientation (allopathic, ayurveda, homeopathy etc.) and comple ity of
organization(informal, part time to large specialty centers).

According to Financial orientation private health sector consists of-

1.For-profit organization.
Includes Individual practitioners from various systems of medicine
,private clinics ,dispensaries ,Private Hospitals and Health Insurance
companies etc.

2.Not-for-profit organization.
Includes NGO·s ,Trust hospitals and Charitable hospitals etc.
 ÿ  !& !#&  $
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provide general health services, 54%
   
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1. Donations.
2. government funding as grants-in-aid.
3. funding from foreign donors.
4. corporate funding.
5. user fees
Patterns of foreign funding
 mosts of care at not
not--for-
for-profit facilities

V Average total e penditure per hospitalization in a charitable institution is less

than in for-profit hospitals but higher than in public sector hospitals.
V the 52nd round of the NSS also brings out the fact that there was a decrease in
access to free care from 19% to 10% between 1986 and 1996. This reflects the
fact that user fees have been introduced in several public and not-for-profit
health institutions during this period'
 Yor Profit organizations

V Defination:-A business or other organization whose primary goal is making

money(a profit, as opposed to a non profit organization which focuses a goal such as
helping the community and is concerned with money only as much as necessary to
keep the organization operating.

V For profit organizations consists of individual physicians, dispensaries and clinics

private (for-profit) nursing homes and corporate hospitals. Dispensaries and the
clinics are run by individual physicians (or by group of physicians) who provide
health care on fee-for-service basis and for profit in different lines of medicine like
allopathy, homeopathy, ayurveda etc.
 Yor Profit Organizations in Private sector.

V The Government contributes 20% to the total healthcare e penditure

in India, the remaining 80% comes from the private sector.
V India has one of the highest private spending in healthcare as
compared to other countries.
 Yunding in Private for profit organisations.
organisations.

V Private providers include private hospitals, clinics and pharmaceutical

companies which are financed through-fee for service.
V private and social insurance financed through individual or company
premiums.
V donations .
V contributions from both government and private households. The
direct or indirect support from government comes inform of
subsidies, ta e emptions and trained medical staff.
V Grants ,loans and support from multilateral agencies,banks and other
corporates.
V Since most of Private hospitals are either owned by sole ownership or
by partnership or by stakeholders the capital is raised accordingly.
V Several NRIs and industrial/pharmaceutical companies are investing
money in hospitals like Medinova,CDR, Mediciti.
V Apollo Hospitals raise a substantial proportion of their resources from
the stock market.
V Over half of the finances are obtained through long-term bank loans.
mollaborative model between Private Players and State
Governments

V Allocation of and and Building by the State

V Operation and infrastructure management undertaken by the

private player.

V Profits are shared in an equitable ratio.

V Free of cost services to patients below the poverty line.

V Successful a ample: Rajiv Gandhi Super Specialty Hospital

ë Partnership between the Government of Karnataka and Apollo Hospitals Group
ë Financial support from the OPaC Fund for International Development
ë Provides low cost specialty care to families below the poverty line
ë and and Building provided by the State, 30% of profits retained by Apollo
V Venture Funds
ë Aavishkaar is a microfinance venture fund that invests in
commercially viable enterprises that have a social impact.
ë Investees include Swas Healthcare, Vaatsalya.

Project Finance from Commercial Banks

Medanta ² MediCity received a tremendous response to its debt
syndication of Rs. 500 crores from PS^ banks
 Health insurance Definition and scenario in India

V Definition in Indian conte t:-In its broader sense, it would be any arrangement that helps to
defer, delay ,reduce or altogether avoid payment for health care incurred by individuals
and households.
- in a narrow sense would be ¶an individual or group purchasing health care coverage in
advance by paying a fee called premium.·

V SOCIA SaC^RITY FOR MaDICA aMaRGaNCIaS IS NOT NaW TO THa INDIAN aTHOS.
-¶piruvu· (a collection) to support a household with a sick patient.

The Indian health insurance scenario is a mix of-

(1) Voluntary health insurance schemes or private-for-profit schemes;
(2) amployer-based schemes;
(3) Insurance offered by NGOs / community based health insurance, an
(4) Mandatory health insurance schemes or government run schemes (namely aSIS, CGHS).
 


 

V Voluntary Health Insurance can be broadly divided into

V a)Pubic sector b) Private sector.

V Public sector includes the General Insurance Corporation (GIC) and its four
subsidiary companies (National Insurance Corporation, New India Assurance
Company, Oriental Insurance Company and ^nited Insurance Company) and the
ife Insurance Corporation (IC) of India provide voluntary insurance schemes.

V Private Insurance includes insurance companies such as Bajaj Alliance, ICICI,

Royal Sundaram, and Cholamandalam etc.
 Public sector of Voluntary Health Insurance

V The Medical Insurance Scheme or Mediclaim was introduced in November

1986 which is the main product of GIC and covers individuals and groups with
persons aged 5 -80 yrs.
V Premiums are calculated based on age and the sum insured, which in turn
varies from Rs 15 000 to Rs 5 00 000. In 1995/96 about half a million
Mediclaim policies were issued with about 1.8 million beneficiaries (Krause
Patrick 2000). The coverage for the year 2000-01 was around 7.2 million.
V The four public insurance companies collected a premium of Rs 1128.64 crore
under Mediclaim from 97 lakh insured's out of total of 112 lakh.
V Another scheme, namely the Jan Arogya Bima policy specifically targets the
poor population groups covers reimbursement of hospitalization costs up to
Rs 5 000 annually for an individual premium of Rs 100 a year and family
discount of 30% is granted, but there is no group discount or agent
commission.
V The Jan Arogya Bima Scheme had only covered 400 000 individuals by 1997.
 Voluntary health insurance Private Insurance
providers.

V The year 1999 marked the beginning of a new era for health insurance
in the Indian conte t with the passing of the Insurance Regulatory
Development Authority Bill (IRDA).
V This bill not only promoted private players to enter the health
insurance sector but also protected the interests of policy holders.
V a amples for the same are Bajaj Alliance, ICICI, Royal Sundaram, and
Cholamandalam among others are offering health insurance schemes.
V murrent scenario in Private Health Insurance
V At present, 12 general insurance companies and 25 TPAs.
V The total number of insurance holders is reported to be 112 akh with
private insurance holding 10% of the total.
Health Insurance market share
montribution of Public and Private Health Insurance to
Total Health insurance of India
 Individual and Group Insurance moverage by
Government and Private mompanies 2002-
2002-03 and
2003--04
2003
Break--Down of Health Premium between Government-
Break Government-
owned and Private Non-
Non-Life Insurers
 Employers offered insurance coverage

V amployers in both the public and private sector offers employer-based

insurance schemes .
1. lump sum payments.
2. reimbursement of employee·s health e penditure .
3. fi ed medical allowance.
4. monthly or annual irrespective of actual e penses.
5. covering them under the group health insurance policy(it could be
public or private health insurance company).
For e ample-railways, defense and security forces, plantations
sector and mining sector.
V The population coverage under these schemes is minimal, about 30-50
million people.
 NGOs / community-
community-based health insurance

V Community-based funds refer to schemes where members prepay

a set amount each year for specified services.
V Planning of the schemes and allocation financial resources depends
on defining contribution level of target population and collecting
mechanisms, defining the content of the benefit package.
V Such schemes are generally run by trust hospitals or non
governmental organizations (NGOs).
V The benefits offered are mainly in terms of preventive care, though
ambulatory and in-patient care is also covered.
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V Such schemes tend to be financed through ²

1)patient collection.
2)government grants
3) donations.
V CBHI schemes are negotiating with the for profit insurers for the
purchase of custom designed group insurance policies however
coverage of such schemes are low , covering about 30-50 million.
V Such schemes are struggling to meet their e tensive financial
requirement.
 mase Study of mBHI.

V Self-amployed Women·s Association (SaWA), Gujarat:

V astablished in 1992, this scheme provides health, life and assets insurance
to women working in the informal sector and their families in collaboration
with National Insurance Company(NIC). The enrolment in the year 2002
was 93,000.
V a premium of Rs 85 per individual is paid by the woman for life, health and
assets insurance. At an additional payment of Rs 55, her husband too can
be covered. Rs 20 per member is then paid to the National Insurance
Company (NIC) which provides coverage to a ma imum of Rs2 000 per
person per year for hospitalization.
V The e penses incurred for treatment /hospitalization are settled in/by
reimbursement.
V The responsibility for enrolment of members, for processing and
approving of claims rests with SaWA. NIC in turn receives premiums from
SaWA annually and pays them a lumpsum on a monthly basis for all claims
reimbursed.
 Other mommunity Based health Insurance Schemes.

V The Mallur Milk Cooperative in Karnataka .

V Tribhuvandas Foundation (TF), Anand(Gujrat).
V Similar scheme was established in 1972 at Sewagram, Wardha in
Maharashtra.
V The Action for Community Organization, Rehabilitation and
Development (ACCORD), Nilgiris, Tamil Nadu .
V Kadamalai Kalanjia Vattara Sangam (KKVS), Madurai.
V Raigarh Ambikapur Health Association (RAHA), Chhatisgarh
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